Renal and Urologic System

Question 1

The Nephron

Answer 1

filters fluid. reabsorbs fluid. forms a filtrate of protein- free plasma. maintains body fluid volume. maintains electrolyte composition. maintains body pH within narrow limits

Question 2

Glmerulus/ Bowman’s Capsule

Answer 2

kidney receives 20% of cardiac output
20% of plasma is filtered into the renal tubules
urinary output= 1.5 L per day so most fluid is reabsorbed back from the tubules

Question 3

Glomerular Filtration Rate

Answer 3

rate of PLASMA filtration by Glomerulus. Best overall estimate of renal FUNCTION

Question 4

What is used to measure GFR

Answer 4

creatinine clearance (a muscle metabolism byproduct and has fairly constant plasma level)

Question 5

plasma creatinine concentration level alone

Answer 5

used to monitor GFR. substantial GFR changes may be reflected in relatively small plasma creatinine changes
SENSITIVE test for renal function. Inversely related to GFR

Question 6

BUN

Answer 6

urea nitrogen in the blood.

clinically relevant labs for kidney disease

Question 7

Urinalysis

Answer 7

(color, turbidity, protein, pH, specific gravity, sediment*, supernatant) best test for infectious agents and foreign materials such as toxins, drugs

Question 8

Diuretics

Answer 8

inhibit Na+ uptake (reduced removal from tubular fluid) so more H2O remains in the tubule and urine

Question 9

What do you see clinically when someone takes a diuretic?

Answer 9

increased urination/micturition
decreased BP
decreased edema
decreased CHF

Question 10

pathologies of the renal system

Answer 10

infections (UTI, pyelonephritis)
cancer (renal cell carcinoma, bladder cancer)
renal cystic disease
renal calculi
chronic renal failure
glomerulonephritis (nephrotic syndrome, nephritic syndrome)
neurogenic disorders
urinary incontinence

Question 11

UTI symptoms

Answer 11

urethritis (inflammation/ pain at the urethral opening. painful urination)
cystitis/bladder infection (painful urination, frequent urination, an urgent need to urinate, urine may be cloudy or bloody, fever is sometimes present (fever may not be present for older adults so look for CONFUSION)

Question 12

cystitis (aka bladder infection)

Answer 12

dysuria (painful urination), urinary frequency, urinary urgency, suprapubic pain, low back pain, cloudy urine, bloody urine, flank pain

Question 13

pyelonephritis (kidney infection)

Answer 13

symptoms suggesting bladder infections. usually abrupt onset. high fever or chills, BACK PAIN localized around the infected kidney is quite common ranging from mild discomfort to sharp, stabbing pain. Nausea and vomiting also possible

Question 14

kidney/ urinary tract infections- treatment

Answer 14

antibiotics
increased fluids
consider Lactobacillus acidophilus to prevent yeast growth when taking antibiotics
if person does not show improvements within 48-72 hours, contact physician

Question 15

Renal Cell Carcinoma

Answer 15

malignant tumor; 80-90% of all renal neoplasms
M (over 60) x2> F
metastasis to lungs, skeleton

Question 16

Renal Cell Carcinoma signs and symptoms

Answer 16

bloody urine, abdominal/ flank pain, palpable mass; can produce HTN, hyperparathyroidism
only 10% of cases (poor prognosis)
hematuria (blood in urine) 50% of cases

Question 17

Renal Cell Carcinoma Eval and Treat

Answer 17

radiographic imaging, surgical removal

Question 18

Renal Cell Carcinoma: Risk Factors

Answer 18

Tobacco use (smoking), obesity, HTN (d/t diuretic use), decreased fruits and vegetables in diet, increased red meat in diet, occupational toxins (solvents, asbestos)

Question 19

Bladder Cancer

Answer 19

Transitional cell cancer.
M 4x > W
metastses to bone or perimetric lymph nodes may cause low BP

Question 20

Bladder cancer (signs and symptoms)

Answer 20

hematuria (blood in urine), frequency, urgency, dysuria

Question 21

bladder cancer prevention

Answer 21

tobacco cessation (50% of causes are related to cigarette smoking)
vitamin/ zinc supplements and immunotherapy may reduce recurrence by 40%
screening men at risk over 50 significantly lowers incidence, mortality

Question 22

Bladder Cancer Treatment

Answer 22

resection of pelvic lymph nodes, prostate/seminal vesicles, uterus; radiation and chemotherapy; salvage cystectomy and/or transplantation

Question 23

Renal Failure (ARF- acute renal failure) (chronic renal failure)

Answer 23

acute- multiple causes, including impaired renal blood flow (reversible)
chronic- irreversible

Question 24

Indicators of Chronic Renal Failure

Answer 24

GFR falls

uremia- accumulation of toxins in the blood

Question 25

signs and symptoms of chronic renal failure

Answer 25

anorexia, nausea, vomiting, fatigue, HTN, pruritus, decreased urine output, edema, neurological changes

Question 26

Evaluation and treatment of chronic renal failure

Answer 26

(early) regulated food & fluid intake, Na & K restriction; (later) dialysis transplantation

Question 27

see chronic renal failure stages

Answer 27

go to slide 25

Question 28

systemic manifestations of kidney failure

Answer 28

urinary, cardiopulm, GI, nervous system, integumentary, hematopoietic, skeletal, endocrine

Question 29

What is the leading cause of kidney failure?

Answer 29

Diabetic Nephropathy

Question 30

Dialysis (2 types) both methods have Risk of infection for immunosuppressed patients

Answer 30

hemodialysis- 3x week at 3-4 hours

peritoneal dialysis- 3x daily

Question 31

dialysis considerations slide

Answer 31

slide 29

Question 32

PT considerations in CRF

Answer 32

co-morbidities, esp in CV system
immunosuppression when on dialysis
fatigue associated with dialysis (timing of therapy sessions)
impaired O2 transport (w/ dialysis) limits exercise ability; consider Borg scale
exercise may help control BP (consider with HTN)- monitor BP on opposite arm!!!
exercise during HD but some do not want to or the setup isn’t right

Question 33

PT considerations for CRF (2)
“a timely and effective rehabilitation program can improve quality of life, endurance, and functional abilities toward greater independence
4-6x per week, low capacity interval training (30min)

Answer 33

VO2 Max is 1/3 - 1/2 normal rates
positive s&s for anemia, fatigue, mm wasting, reduced work capacity, reduced caridiac performance and reduced mm mass
improvement shown with 40-70% target HR 3 times a week

Question 34

Neurogenic Bladder

Answer 34

spastic bladder dysfunction
hypotonic (flaccid) bladder dysfunction
pathophysiology: interrupted innervation results in loss of control; may result in partial or complete urinary retention, incontinence, urgency or frequency

Question 35

Neurogenic bladder s&s

Answer 35

burning sensation, no pain; infection commonly develops in spastic bladder

Question 36

neurogenic bladder eval and treat

Answer 36

catheterization, bladder training, surgery, pharmacologic interventions

Question 37

Examples Urinary Incontinence

Answer 37

functional incontinence, overflow incontinence, stress incontinence, urge incontinence

Question 38

functional incontinence

Answer 38

normal control but difficulty getting to toilet or facilities (d/t decreased locomotion ability)

Question 39

overflow incontinence

Answer 39

dribbling with a constantly full bladder; occurs when urinary outlet is obstructed. obstruction in renal system

Question 40

Stress incontinence

Answer 40

insufficiency (“weakness”) of pelvic floor muscles. uncontrollable voiding when intravesical pressure> extravesical pressure (giggle, coughing, sneezing, exercise, lifting) KEGELS

Question 41

Urge incontinence

Answer 41

hypertonicity of bladder or pelvic floor muscles. sudden and uncontrollable need to void; suggests neurologic condition (spastic bladder)
1 or more episode per week are 34% more likely to sustain fracture due to falls at night